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The Affordable Care Act (ACA) • Overview – – – – – Housekeeping (Introduction, Questions, Timing, ) Why Pre-Retirees are interested in the ACA Affordable Care Act Important Changes How much does health care cost Health plans offered through Covered California in Butte County – Scenarios – If I missed open enrollment – Questions Why do “pre retirees” care about the Affordable Care Act? Not currently employed and so, without employer-sponsored insurance Previously rejected by insurers for pre-existing conditions Waiting for Medicare Not previously categorically eligible for MediCal (no children, not aged and not disabled) Their children not quite launched and no employer-sponsored health care (18-26yrs.) Taking care of older adult parents and wondering if this effects them Affordable Care Act Basics Important Changes Standard comprehensive benefits – – – – – – – – – – Ambulatory patient services Emergency services. Hospitalization. Maternity and newborn care. Mental health and substance use disorder services, including behavioral health treatment. Prescription drugs. Rehabilitative and habilitative services and devices. Laboratory services. Preventive and wellness services and chronic disease management. Pediatric services, including dental and vision care. Affordable Care Act Basics Important Changes – No denial or higher premiums for those with preexisting conditions – Coverage of preventative care without cost sharing – No lifetime or annual limits in health insurance policies – Limiting changes in premium related to age How much does Health insurance cost? 1) Expanded MediCal Assistance Free coverage for persons with incomes up to 138% of poverty), which is income of less than $15,856 for an individual Childless, non elderly and non disabled persons 2) Sliding Scale of premium subsidy amounts139% of poverty to 400% of poverty, which is $15,857-$28,725 for an individual How much does Health insurance cost? (continued) 3). Help with the out of pocket costs, such as copayments -Up to 250% of poverty or $15, 857-$28,725 for an individual. 4). Covered California Plans without subsidies (above 400% of poverty) – Four levels of coverage and a minimum coverage plan (for those with special hardship circumstances and under 30) – Your choice: Higher monthly premium, so when you need coverage you pay less, or lower monthly premium and if you need coverage you will pay more. Health plans offered through Covered California in Butte County • Anthem Blue Cross of California (PPO) • Blue Shield of California (EPO) Types of Health Plans offered in Butte County through Covered California Preferred provider organization (PPO) plan – • An indemnity plan where coverage is provided to participants through a network of selected health care providers (such as hospitals and physicians). • The enrollees may go outside the network, but would incur larger costs in the form of higher deductibles, higher coinsurance rates, or non-discounted charges from the providers. Exclusive provider organization (EPO) plan – • A more restrictive type of preferred provider organization plan under which employees must use providers from the specified network of physicians and hospitals to receive coverage; • there is no coverage for care received from a non-network provider except in an emergency situation. Scenarios • 62 year old and 63 year old married individuals, • 55 year old, single annual household individual who works 20 income is $54,000. hours a week and makes $10.00 an hour • Bronze PPO plan starts or $10,400 a year. at $27 a month premium (with subsidy), • Likely qualified for up to $948 monthly expanded MediCal, free premium (with subsidy) coverage for a Platinum PPO plan for the couple If I missed open enrollment…. • MediCal has no special open enrollment period, every day is open enrollment • If you have qualifying life event, e.g., loss of employer-sponsored health insurance, lose your MediCal eligibility due to an increase in income, marriage, you may sign up for coverage within 60 days of that event with a special enrollment. • Tax Penalty is $95. for an individual or 1 percent of yearly income whichever is larger. The fee will increase in 2015 and 2016. Questions? Thank you!